A long-term prognosis of patients with adult Still's disease (ASD) depends on
the sequelae of chronic arthritis. We tried to determine the characteristics
and risk factors of ASD patients with chronic arthritis. Thirty-five Japanese
patients with ASD (13 males and 22 females, the mean age at disease onset =
34.0 years old) were classified to two groups; patients with chronic arthritis
(>6 months, chronic articular ASD, 49%) or without chronic arthritis
(systemic ASD, 51%). Clinical and laboratory findings including serum cytokine
levels and HLA class II alleles were compared between both groups.

In patients with chronic articular ASD, female was more frequent (82% vs.
44%, p<0.05) but liver dysfunction and myalgia were rarer (18% vs. 50%;
p<0.05, 13% vs. 65%; p<0.05) than in systemic ASD. At disease onset,
synovitis of MP and PIP joints were frequently observed in chronic articular
ASD but not in systemic ASD (p<0.05). Hypergammaglobulinemia was more but
leukocytosis was less distinct in chronic articular ASD than in systemic ASD.
It was noted that, different from systemic ASD, the serum level of IFNg and
IL-8 were not decreased in chronic articular ASD even when systemic disease
activity including CRP or serum IL-6 level was low. The analysis of HLA
class II alleles by PCR-RFLP/SSP showed that DRB1*1501 [DR2] (53% vs. 16%,
OR = 5.9; p<0.05), DRB1*1201 [DR5] (27% vs. 4%, OR = 7.9; p<0.05),
DQB1*0602 [DQ1] (42% vs. 15%, OR = 4.1; p<0.05), and DQB1*0302 [DQ3] (33%
vs. 9%, OR = 5.2; p<0.05) was more frequent in chronic articular ASD than
in normal healthy control.

These results suggest that chronic articular ASD seems to have the different
characteristics from that of systemic ASD. Female, MP and PIP joint
synovitis at disease onset, or HLA class II should be noted as a risk factor
of chronic articular damages of patients with ASD. Additionally, IFNg or
IL-8 may be involved in the pathogenesis of chronic arthritis of ASD.

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